Impact of the use of hydroxyethyl starch in granulocyte apheresis using Spectra Optia

Abstract

Objectives To determine the impact of the use of hydroxyethyl starch (HES) in granulocyte apheresis using Spectra Optia. Background Granulocyte transfusion (GT) is a therapeutic option for neutropenic patients with severe bacterial or fungal infections. Recent studies in emergency medicine have shown the potential risk of using HES, which is routinely used in granulocyte apheresis to increase yield by sedimenting red blood cells. We hypothesized that the use of a newer device (Spectra Optia) would spare the need for HES. Methods We retrospectively compared granulocyte apheresis with HES (HES group, n = 89) and without HES (non‐HES group, n = 36) using Spectra Optia. Results The granulocyte yield was significantly higher in the HES group (7.3 × 1010 vs. 2.0 × 10, p < 0.01) and was attributed to the difference in collection efficiency (36% vs. 7.7%, p < 0.01). The absolute neutrophil count on the following morning of GT was significantly higher in the HES group than in the non‐HES group (2460/μl vs. 505/μl, p < 0.01). There were no significant differences in the occurrence of adverse events between the HES and non‐HES groups. The renal function was unchanged in both groups after apheresis. Conclusions We demonstrated that the advantage of using HES remained unchanged in granulocyte apheresis using Spectra Optia.

How do we…consistently provide high‐dose granulocyte products for transfusions in neutropenic patients?

“…20 The use of hetastarch to generate a better interface between the granulocyte and RBC components has been shown to improve granulocyte yield and minimize RBC contamination. 21 The use of hetastarch in conjunction with Spectra Optia apheresis in our study was able to generate a product in which 96.5% of units contained ANC yields greater than the 4.0 Â 10 10 granulocyte per unit while 97.6% of units contained RBC volume less than 30 mL. 3,7 Collections typically take 2-3 h but may take longer depending on intake procedures, staffing levels, and alterations to the standard collection rate.…”

“…It is important to minimize RBC contamination, which can be a challenge given that RBCs and granulocytes have similar specific gravities 20 . The use of hetastarch to generate a better interface between the granulocyte and RBC components has been shown to improve granulocyte yield and minimize RBC contamination 21 . The use of hetastarch in conjunction with Spectra Optia apheresis in our study was able to generate a product in which 96.5% of units contained ANC yields greater than the 4.0 × 10 10 granulocyte per unit while 97.6% of units contained RBC volume less than 30 mL 3,7 .…”

Comparison of two apheresis systems for granulocyte collection without hydroxyethyl starch

“…The administration of G-CSF on the day before apheresis markedly increases the number of granulocytes collected. Using HES to enhance red blood cell sedimentation prior to GC can also increase the efficiency of GC [10,11].…”

“…The number of granulocytes collected may affect the effectiveness of GTX. A previous report found that using HES to collect more granulocytes was still advantageous when granulocyte apheresis was performed using Spectra Optia [11].…”